Provider Demographics
NPI:1982269296
Name:FOREMAN, KIMBERLY A (LISW-S)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 EASTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-3125
Mailing Address - Country:US
Mailing Address - Phone:606-367-4926
Mailing Address - Fax:
Practice Address - Street 1:207 PORTAGE TRAIL EXT W
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1330
Practice Address - Country:US
Practice Address - Phone:888-227-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11008931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical